Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes

Hakan Kalaycı,Şafak Yılmaz Baran,Esra Bulgan Kılıçdağ,Serdinç Özdoğan,Songül Alemdaroğlu,Gülşen Doğan Durdağ,Seda Yüksel Şimşek

doi:10.4274/jtgga.galenos.2019.2019.0078

Hakan Kalaycı, Şafak Yılmaz Baran + Show 5 more

Open Access

https://doi.org/10.4274/jtgga.galenos.2019.2019.0078

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Abstract

Objective:Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodies can cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy, and to investigate neonatal outcomes.Material and Methods:This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITP diagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessedResults:Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar.Conclusion:Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients should be followed closely in cooperation with the hematology department.

Highlights

Thrombocytopenia, which is defined as a platelet count being less than 150x103/μL, occurs in approximately 7% of pregnant women (1)
Probability of severe thrombocytopenia at delivery is higher in patients with idiopathic thrombocytopenic purpura (ITP) who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses
The neonatal thrombocytopenia rate was 8.6% in our study, and we found no significant difference between the ITP and chronic ITP groups in this aspect

Summary

Introduction

Thrombocytopenia, which is defined as a platelet count being less than 150x103/μL, occurs in approximately 7% of pregnant women (1). The most commonly seen, gestational thrombocytopenia and idiopathic thrombocytopenic purpura (ITP), are both diagnoses of exclusion of other pathologies necessitating different treatment strategies. These pathologies include preeclampsia; HELLP syndrome characterized by hemolysis, elevated liver enzymes and low platelet count; sepsis; disseminated intravascular coagulation; autoimmune diseases such as systemic lupus erythematosus, thrombotic thrombocytopenic purpura; microangiopathies such as hemolytic uremic syndrome; hematologic malignancies; and drug-induced thrombocytopenia (2-4). Gestational thrombocytopenia, which usually occurs in the midsecond to third trimester and which is a mild form with platelet counts more than 70x103/μL, constitutes 70-80% of cases (1,5)

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